MARKET WATCH
MYOPIA RISE AND VISION
H E A LT H I S S U E S L E F T I N
ITS WAKE
Myopia continues to be a growing problem around the world. A recent study1 predicts
that by 2050 about half of the world’s population will be myopic. While genetics plays a
role, researchers point to the increasingly digital lifestyles of young people as one culprit
of the epidemic. The sheer volume of this vision impairment will have consequences not
only for those with it, but also for the communities and nations where they live, work or
go to school.
Maureen Cavanagh
President of the Vision Impact Institute,
USA
Maureen Cavanagh is the president of the Vision Impact
Institute. She joined Essilor in 2005 and has held various
executive leadership positions within the company.
Cavanagh has extensive experience in vision healthcare,
having worked for Johnson & Johnson’s Vistakon and
Spectacle Lens divisions before joining Essilor. Cavanagh
earned her bachelor’s degree from Bridgewater State
University. She has received numerous industry awards,
including the Optical Women’s Association (OWA)
Pleiades Award in 2015 and Jobson’s Most Influential
Women in Optical 2012. Cavanagh was appointed
President of the OWA in July 2016.
www. visionimpactinstitute.org
KEYWORDS
Myopia, myopic, blindness, vision impairment, eye disease,
digital eye strain, digital screen(s), public health, Asia
www.pointsdevue.com
A
s our world grows and develops, our vision is getting
worse. That’s the takeaway from an important body
of research data about the world’s vision, with a
laser focus on myopia and its impact.
The statistics are alarming – myopia is projected to affect
almost half of the world’s population by 2050.1 The
consequences are just as unsettling, as myopia, when left
uncorrected, can lead to severe vision impairment and
even blindness. By mid-century, nearly 5 billion will have
the vision impairment with about 1 billion suffering from
high myopia. In the United States and Canada, the number
of myopic is estimated to climb to 260 million, or close to
half of the population, up from 89 million in 2000; and
high myopia cases jump an astounding five times to 66
million by that year.1
These are part of the findings of a meta-analysis by the
Brien Holden Vision Institute, of 145 studies covering 2.1
million people.1 Also known as nearsightedness, myopia is
a refractive error that causes items close by to be seen
distinctly while distance vision is blurry. High myopia is a
severe form in which the eyeball becomes too long and
can lead to retinopathies or even retinal detachment.
Young people are becoming myopic at an alarming rate in
many countries – insuring that they will have a lifetime of
blurry vision unless they get the aid of optical prescription
(eyeglasses, contact lenses, ortho-k) or have refractive
surgery. This will have long-term consequences for public
health around the globe, especially in less-developed
regions where healthcare delivery is more challenged.
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Myopia epidemic in parts of Asia

2000 2050 Research indicates there are regional variations in the

prevalence of myopia. Asia – the world’s largest and most
1.4 billion 4.758 billion populous continent – is perhaps where its impact is more
widespread. And East Asia – comprised of China, Japan,
Myopia Hong Kong, Mongolia, North Korea, South Korea and
22.9 percent of 49.8 percent of
world population world population Taiwan – is experiencing an epidemic with reports as high
as 40 percent in Japan and 50 percent in Taiwan.2 The
prevalence of myopia is more than two times higher among
163 million 938 million East Asians than white people of the same age.2
High Myopia
2.7 percent of 9.8 percent of China is especially hard hit. As it is the most populous
world population world population country on Earth, it also has the largest population with
vision defects. The results of the recent domestic white
TAB Myopia estimates1
paper on China’s National Vision Health, (conducted by
Prof. Li Ling, Head of the China Center for Health
“Two things are extremely worrying about these Development) are alarming. In 2012, close to 500 million
projections,” said Professor Kovin Naidoo, CEO of the people over the age of five had an uncorrected visual
Brien Holden Institute and Vision Impact Institute advisory defect in China, among which 450 million had myopia. By
board member. “First, the accelerated growth of cases of 2020, nearly 700 million people are expected to have
myopia is incredible, which speaks to how our contemporary myopia in China – twice the population of the United
lifestyles are affecting our behavior. And second is that States. Undeniably, there is a huge increase from 60 years
people with myopia, especially high myopia, are at higher ago when the country was still isolated from the global
risk to develop other vision disorders that can lead to economy and only 10-20 percent of its population had
blindness.” myopia2.

He said that 1 in 10 people worldwide will be at risk for
permanent blindness by the year 2050, as high myopia
especially increases the risk of cataracts, glaucoma,
retinal detachment and myopic macular degeneration – all
of which can cause irreversible vision loss.
A comparative study of six- and seven-year-old students of
Chinese ethnicity in Singapore and Sydney had interesting
results when it explored the prevalence of myopia among
the focus population and possible risk factors.4 The major
finding was that myopia was more prevalent in Singapore

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(29.1 percent) and significantly lower in Sydney (3.3
percent). Hereditary influences were about the same in
both locations: one or more parents reported having
myopia for 68 percent of the students in Sydney and 71
percent in Singapore parents. The primary lifestyle
difference between the two student groups was that the
children in Sydney spent more time outdoors each week
(average of 13.75 hours) than those in Singapore (3.05
hours on average). The researchers also hypothesized that
academic pressure in Singapore schools played a role in
the difference.
However, myopia is not limited to Asian nations. A
retrospective examination of 13 repeated prevalence
studies analyzed data about the changing prevalence of
myopia over 13 years with Israelis from 16 to 22 years
old.5 The overall occurrence of myopia increased
significantly to 28.3 percent in 2002 from 20.3 percent
in 1990. The causes of this increase were not certain;
however, evidence pointed to genetic as well as
environmental components, such as higher amounts of
near work and more years of education.
Research shows similar results in the United States. One
study compared myopia rates from 1971-72 to the period
of 1999-2004, with the later period showing substantially
higher myopia rates than 30 years earlier.6
Some regions and ethnicities report very low rates of
myopia, such as among Australian Aborigines and Solomon
Islanders, where occurrence was in the 2-5 percent range.
And a comparative study of urbanites in the United States
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showed that African-Americans were significantly less
likely to have myopia than whites.5
Lifestyle factors into the spread of myopia
Once thought to be only a matter of genetics, several of
the studies point to lifestyle and environmental
considerations as contributing to the increasing occurrence
of myopia.
According to the Brien Holden Institute meta-analysis of
myopia research data1, “The projected increases are
widely considered to be driven by environmental factors
(nurture), principally lifestyle changes resulting from a
combination of decreased time outdoors and increased
near-work activities, among other factors.”
Many researchers are pointing to the advent of digital
devices in the past 30 years as contributing to the
prevalence of myopia (due to short working distance).
There are now more mobile devices in use around the
globe than there are people on the planet.7
The Holden study points to the under-40 age group,
especially in Asia, as being extremely susceptible to
myopia because of reliance on smartphones, personal
computers and related technology for communications,
entertainment, news and education.1
The competitive education systems in Singapore, Korea,
Taiwan and China are another factor, according to the
study, causing students to spend more time studying at
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“ Myopia will have lo ng - ter m co ns eq uences

for publi c health ar o und the g lo b e,
especially in les s - d evelo p ed r eg io ns wher e
healt hcare d eliver y is mo r e challeng ed . ”

computers. The comparative study of young students in
Sydney and Singapore also referred to this, noting the
competitive academic environment of the island city-
state.4
Socio-economic impact of myopia
While the direct socio-economic impact of myopia has not
been determined yet, the effect of poor vision on the
global economy is well documented. This myopia epidemic
creates a significant public health problem around the
world. The economic burden of uncorrected refractive
error (URE), largely caused by myopia, is estimated to be
more than $269 billion per year8, and that number will
grow as the epidemic spreads. It is affecting developing
nations as well as the developed world. Actually, the Brien
Holden study mentions that developed nations are seeing
a faster rise in myopia because of increased urbanization
and development, which usually means more digital
device use and higher education levels.
The World Health Organization (WHO) reports that URE
for distance is the main cause of low vision and the second
leading cause of blindness after cataracts. WHO estimates
point to URE as a bigger cause of productivity loss globally
than any other preventable vision disorders, with 0.8-4.0
percent of the world’s population affected by visual
impairment in 2007 at an estimated cost of more than
$269 billion per year.8
Research from 2006 showed that more than 3.6 million
Americans suffered from visual impairment, blindness or
other eye diseases in 2004 – creating a financial burden
totaling $35.4 billion. And $8 billion of that total was loss
of productivity. The annual impact to the U.S. government
budget was $13.7 billion.9
The National Medical Research Council of Singapore
commissioned a study of the economic cost of myopia. In
2009, the mean annual direct cost of myopia for school-
aged children in Singapore was $148 (U.S. dollars)
annually, with the median cost at $125 (U.S. dollars) per
student.10
Public health consequences
This spreading myopia scourge will have a long-term
impact on public health and productivity around the world
in the decades ahead. While the number of myopia cases
may be rising faster in developed nations, the impact
could be greater in less-developed countries, where
corrected vision could be the key to getting an education
for a child or an escape from poverty for an adult.

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52 Number 73 - Autumn 2016

More research is required to determine the exact causes
and consequences of myopia. The projections of the
spread of myopia are cause for concern for public health
officials worldwide. As the young people with myopia grow
into middle age, they will be more susceptible to the
pathological effects of the condition, especially those with
high myopia, which will have an impact on public health
services. Officials should start planning and budgeting
now for the coming need.
MARKET WATCH
Admittedly, people around the globe are not going to give
up their digital devices. We are hooked. However, certain
precautions can help avoid digital eye strain, according to
the Vision Council. For students and desk-bound workers,
the optimal optical arrangement is to have the computer
screen at an arm’s length (20-24 inches) distance from
the eyes. Computer eyewear can filter out the potentially
harmful blue light that digital screens emit, as well as
eliminate glare and alleviate eyestrain.13

The antidotes Finally, we need to remember that the most important

The growing body of research about the spread of myopia
is giving us reason for hope. The overwhelming majority of
myopia cases can be corrected with prescription
eyeglasses, contact lenses or refractive surgery.
action in the fight against myopia and its related damage
is to visit a trained eyecare professional for an annual
comprehensive eye examination. This is especially
important for children as their eyes are still developing
and early intervention is key. •

Beyond optical solutions that correct myopia, research

points to increased time outside in sunlight as the antidote
to the condition. In one study, a randomized clinical trial
in Guangzhou, China, researchers followed 952 children
in the intervention group and 951 in the control group
with a mean age of 6.6 years. The cumulative rate of
myopia was 30.4 percent in the intervention group and
39.5 percent in the control group. The important finding
was that 40 minutes of additional activity outside in
natural light resulted in a reduced incidence of myopia
during the next three years.11

More time spent outside playing also means less time

inside in front of a computer or smartphone screen.
Modern lifestyles spent in front of digital screens do have
an impact on vision. The Vision Council reports that 75
percent of Americans who use two or more devices
simultaneously report digital eye strain symptoms, such as
blurry vision and eye fatigue.12

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Number 73 - Autumn 2016 53
MARKET WATCH

“ The most imp o r tant actio n in the fig ht

against myop ia and its r elated d amag e is to
visit a t rained ey ecar e p r o fes s io nal fo r an
annual comp r ehens ive ey e ex aminatio n. ”

REFERENCES
1. Holden B, Fricke T, Wilson D, et al. Global Prevalence of Myopia and High Myopia and Temporal Trends from
2000 through 2050; Ophthalmology, 2016.
2. Pan CW, Dirani M, Cheng CY, Wong TY, Saw SM. The age-specific prevalence of myopia in Asia: a meta-
analysis. Optometry and Vision Science: official publication of the American Academy of Optometry 2015;
92:258-66.
3. Dolgin E. The myopia boom. Nature March 2015;519:276-8. KEY TAKEAWAYS
4. Rose K, Morgan I, Smith W, Burlutsky G, Mitchell P, Saw SM, Myopia, Lifestyle and Schooling in Students of
Chinese Ethnicity in Singapore and Sydney. JAMA Ophthalmology, April 1, 2008.
5. Dayan YB, Levin A, Morad Y, Grotto I, Ben-David R, Goldberg A, Onn E, Avin I, Levi Y, Benyamini O, The
Changing Prevalence of Myopia in Young Adults: A 13-Year Series of Population-Based Prevalence Surveys. IOVS
(Investigative Ophthalmology and Visual Science), August 2005. • Myopia is projected to affect half of the world’s
6. Vitale S, Sperduto RD, Ferris III FL, Increased Prevalence of Myopia in the United States Between 1971-1972
and 1999-2004. JAMA Ophthalmology, Dec. 14, 2009. population by 2050.
7. Boren ZD, There Are Officially More Mobile Devices than People in the World. The Independent, Oct. 7, 2014.
8. Smith TST, Fricke KD, Holden BA, Fricke TD, Naidoo KS, Potential Lost Productivity Resulting from the Global
Burden of URE. Bulletin World Health Organization, 2009.
9. Rein DB, Zhang P, Wirth K, Lee PP, Hoerger TJ, McCall N, Klein R, Tielsch JM, Vijan S, Saaddine J, The
Economic Burden of Major Adult Visual Disorders in the United States. JAMA Ophthalmology, Dec. 1, 2006.
• Young people in Asia are especially susceptible to
10. Lim MCC, Gazzard G, Sim EL, Tong L, Saw SM, Direct Costs of Myopia in Singapore. National Medical
Research Council, 2009.
myopia.
11. He M, Xiang F, Zeng Y, Mei J, Chen Q, Zheng J, Smith W, Rose K, Morgan IG, Effect of Time Spent Outdoors
at School on the Development of Myopia in Children in China: A Randomized Clinical Trial. Journal of the
American Medical Association, Sept. 15, 2015.
12. Eyes Overexposed: The Digital Device Dilemma, 2016 Digital Eye Strain Report. The Vision Council. • There are links between myopia and increasing use of
digital devices, such as smartphones and personal
13. De Larrard B, The new range of Eyezen™ lenses: what are the benefits perceived by wearers during screen
use? Points de Vue, International Review of Ophthalmic Optics, N72, Autumn 2015.

computers.

• Research shows that increased time spent outside in

sunshine can reduce the onset of myopia in young
people.

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54 Number 73 - Autumn 2016
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PRODUCT

P.xx xx

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55 Number 73 - Autumn 2016
 MYOPIA AND EFFECTIVE
PRODUCT
MANAGEMENT SOLUTIONS

Myopia is becoming a real public health concern across the world. The number of myopic
people is increasing rapidly. The prevalence of high myopia is also expected to rise.
Understanding myopia development and methods to slow its progression is currently one of
the biggest stakes for researchers and clinicians from around the world. In this paper, a few
Vision Scientists in Essilor have put together a general overview of myopia condition. They
refresh us with the definition of myopia, its evolution and causes. They describe available
solutions for myopia management and discuss the relative efficacy for each solution. Finally,
they focus on Myopilux®, the specific range of ophthalmic lenses which have been proven
to effectively correct and control myopia progression in children.

Dr. Anna Yeo

B Optom (Hons); M App Sc; Dr. Damien Paillé
PhD, Senior Vision Scientist, B Sc Optom; M Sc; PhD, Senior
Essilor Center of Innovation & Vision Scientist, Essilor Center of
Technology Asia Innovation & Technology Europe

Dr. Anna Yeo Chwee Hong joined Essilor R&D Asia in May 2013
as a Senior Vision Scientist after 23 years teaching in optometry in
Singapore Polytechnic. Her current research interest is on adult
myopia, which she conducted research internally at CI&T Asia and
in collaboration with other teaching institutions such as Zhongshan
University and Singapore and Ngee Ann Polytechnics. She is also a
member of the Scientific Committee in Wenzhou-Essilor International
Research Centre (WEIRC) for which she helps to review research
protocols and scientific publication. She is appointed to be a scientific
adviser in Myopia Control Lenses for Essilor AMERA 2014-2015.
Currently, she is holding the portfolio as a member of the Ethics
Review Committee, Singapore Polytechnic. Dr. Anna Yeo has been a
member of the Optometry and Opticianry Board (OOB) in Singapore
and the Chairperson for the Credentials Committee, OOB since 2008.
Dr. Damien Pailé is a member of Essilor International’s optical
research and development team, based in Paris, France. Damien
holds a degree in optometry and practiced as an optician before
completing and defending a doctoral thesis in 2005 in cognitive
sciences at the University of Paris VIII in collaboration with the College
de France and the Renault company. He then pursued post-doctoral
studies at the Laboratory for Perception and Motion Control in Virtual
Environments (a joint Renault-CNRS laboratory), before joining Essilor
International’s research and development team in 2007. He currently
works in the Vision Sciences department.

Dr. Björn Drobe

Patricia Koh
Optom; B BioMed; MPH,
Technical Manager, Essilor
Mission Division
Born and raised in Singapore, Patricia is an Optometrist with
background on Biomedical Science and Master of Public Health. She
joined Essilor R&D Singapore in 2005, focusing on progressive myopia
in children and looking ethnic differences such as postural behavior.
In 2014, Patricia moved to Essilor Mission Division as Technical
Manager to support the group’s social initiatives on training and
exploring base of the pyramid innovation.
B Sc Optom; M Sc; PhD, Associate
Director, Wenzhou Medical
University - Essilor International
Research Center (WEIRC)
Dr. Björn Drobe obtained a B.Sc. in Optometry, a M.Sc. in Cognitive
Sciences and a Ph.D. in Vision Sciences in Paris, France. He joined
the French Essilor Int. research team in 1998, working mainly on the
interaction between ophthalmic lenses and the human visual system,
as well as on progressive myopia in children. From 2007 to 2013, Dr.
Drobe relocated to Essilor R&D Singapore for a higher involvement
in myopia research. Since June 2013, he is the associate director of
WEIRC (Wenzhou Medical University – Essilor International Research
Center), managing an international research team on myopia in
children.

KEYWORDS
Myopia, myopia control, myopia correction, high myopia risks, hyperopic
defocus, accommodative lag, heredity, lifestyle, blue light, dopamine,
atropine, Ortho-K, orthokeratology, prismatic bifocal lenses, multifocal
contact lenses, progressive addition lenses, refractive surgery, outdoor light
exposure, Myopilux

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56 Number 73 - Autumn 2016